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Attributes | |
ACN | 627668 |
Time | |
Date | 200407 |
Day | Tue |
Local Time Of Day | 1201 To 1800 |
Place | |
Locale Reference | airport : zzz.airport |
State Reference | US |
Altitude | agl single value : 0 |
Environment | |
Light | Daylight |
Aircraft 1 | |
Operator | common carrier : air carrier |
Make Model Name | B737-500 |
Operating Under FAR Part | Part 121 |
Flight Phase | ground : maintenance |
Flight Plan | IFR |
Person 1 | |
Affiliation | company : air carrier |
Function | maintenance : technician |
Qualification | technician : powerplant technician : airframe |
ASRS Report | 627668 |
Person 2 | |
Affiliation | company : air carrier |
Function | maintenance : technician |
Qualification | technician : airframe technician : powerplant |
ASRS Report | 627670 |
Events | |
Anomaly | aircraft equipment problem : critical maintenance problem : improper documentation maintenance problem : improper maintenance non adherence : published procedure non adherence : far |
Resolutory Action | none taken : detected after the fact |
Consequence | other other |
Factors | |
Maintenance | performance deficiency : repair |
Supplementary | |
Problem Areas | Aircraft Maintenance Human Performance Chart Or Publication |
Primary Problem | Maintenance Human Performance |
Narrative:
On july/mon/2004 aircraft mechanic and I were assigned to perform the thrust reverser slider to track engagement check si 70719-78 on the #1 engine. The inboard slider to track engagement was within limits and greater than 30%. The outboard forward slider to track engagement was right at 30%, but then noticed the aft lower slide on the sleeve had some play. After discussing with my lead, I wrote a non-routine card to change the outboard sleeve. We did not have a sleeve in stock and had to wait until the next day. Then july/tue/2004 I came into work and was assigned along with aircraft mechanic to remove and install the outboard thrust reverser sleeve per amm 78-31-02-4. We removed the bad sleeve and the lower aft slider on the sleeve looked worn. The track on the thrust reverser itself had no noticeable wear. We unpacked the new sleeve and everything looked in order. Per amm 78-31-02-4, we engaged the new sleeve into the tracks and checked for full engagement of the outboard #1 engine thrust reverser sleeve tracks which it was and then slid the sleeve forward. I then connected the blocker doors while aircraft mechanic attached the rod ends on the actuators to the sleeve. After hardware was installed, I had inspector come and inspect the installation of the sleeve. After inspection, I then installed the two cascades that were removed for access. I then had inspector inspect the installation of the cascades. Once completed with the installation, we could not have power on the aircraft to run hydraulics, so I added a subtask for an operational check to be completed. Callback conversation with reporter revealed the following information: the reporter stated the first flight after replacement of the left engine outboard thrust reverser sleeve, the outer composite cover departed the aircraft. The reporter said the sleeve was inspected for condition and was found serviceable with no parts missing and no scratched or dented composite outer cover. The reporter stated the sleeve assembly had been overhauled at a contract vendor and looked new. Callback conversation with reporter acn 627671 revealed the following information: the reporter stated all the job cards and non routine cards were checked for proper signoffs for the installation of the left engine outboard thrust reverser sleeve. The reporter said all paperwork was complete and the logbook signed. The reporter stated on the first flight the composite outer liner of the left engine outboard thrust reverser departed the aircraft. The reporter said the sleeve was repaired and returned serviceable by a contract vendor. Callback conversation with reporter acn 627670 revealed the following information: the reporter stated he cannot remember the incident.
Original NASA ASRS Text
Title: A B757-500 WAS RELEASED FOR SVC AND ON THE FIRST FLT THE L ENG OUTBOARD THRUST REVERSER OUTER SLEEVE COMPOSITE COVER DEPARTED THE ACFT.
Narrative: ON JULY/MON/2004 ACFT MECHANIC AND I WERE ASSIGNED TO PERFORM THE THRUST REVERSER SLIDER TO TRACK ENGAGEMENT CHECK SI 70719-78 ON THE #1 ENG. THE INBOARD SLIDER TO TRACK ENGAGEMENT WAS WITHIN LIMITS AND GREATER THAN 30%. THE OUTBOARD FORWARD SLIDER TO TRACK ENGAGEMENT WAS RIGHT AT 30%, BUT THEN NOTICED THE AFT LOWER SLIDE ON THE SLEEVE HAD SOME PLAY. AFTER DISCUSSING WITH MY LEAD, I WROTE A NON-ROUTINE CARD TO CHANGE THE OUTBOARD SLEEVE. WE DID NOT HAVE A SLEEVE IN STOCK AND HAD TO WAIT UNTIL THE NEXT DAY. THEN JULY/TUE/2004 I CAME INTO WORK AND WAS ASSIGNED ALONG WITH ACFT MECHANIC TO REMOVE AND INSTALL THE OUTBOARD THRUST REVERSER SLEEVE PER AMM 78-31-02-4. WE REMOVED THE BAD SLEEVE AND THE LOWER AFT SLIDER ON THE SLEEVE LOOKED WORN. THE TRACK ON THE THRUST REVERSER ITSELF HAD NO NOTICEABLE WEAR. WE UNPACKED THE NEW SLEEVE AND EVERYTHING LOOKED IN ORDER. PER AMM 78-31-02-4, WE ENGAGED THE NEW SLEEVE INTO THE TRACKS AND CHECKED FOR FULL ENGAGEMENT OF THE OUTBOARD #1 ENG THRUST REVERSER SLEEVE TRACKS WHICH IT WAS AND THEN SLID THE SLEEVE FORWARD. I THEN CONNECTED THE BLOCKER DOORS WHILE ACFT MECHANIC ATTACHED THE ROD ENDS ON THE ACTUATORS TO THE SLEEVE. AFTER HARDWARE WAS INSTALLED, I HAD INSPECTOR COME AND INSPECT THE INSTALLATION OF THE SLEEVE. AFTER INSPECTION, I THEN INSTALLED THE TWO CASCADES THAT WERE REMOVED FOR ACCESS. I THEN HAD INSPECTOR INSPECT THE INSTALLATION OF THE CASCADES. ONCE COMPLETED WITH THE INSTALLATION, WE COULD NOT HAVE POWER ON THE ACFT TO RUN HYDRAULICS, SO I ADDED A SUBTASK FOR AN OPERATIONAL CHECK TO BE COMPLETED. CALLBACK CONVERSATION WITH RPTR REVEALED THE FOLLOWING INFO: THE RPTR STATED THE FIRST FLT AFTER REPLACEMENT OF THE L ENG OUTBOARD THRUST REVERSER SLEEVE, THE OUTER COMPOSITE COVER DEPARTED THE ACFT. THE RPTR SAID THE SLEEVE WAS INSPECTED FOR CONDITION AND WAS FOUND SERVICEABLE WITH NO PARTS MISSING AND NO SCRATCHED OR DENTED COMPOSITE OUTER COVER. THE RPTR STATED THE SLEEVE ASSEMBLY HAD BEEN OVERHAULED AT A CONTRACT VENDOR AND LOOKED NEW. CALLBACK CONVERSATION WITH RPTR ACN 627671 REVEALED THE FOLLOWING INFO: THE RPTR STATED ALL THE JOB CARDS AND NON ROUTINE CARDS WERE CHECKED FOR PROPER SIGNOFFS FOR THE INSTALLATION OF THE L ENG OUTBOARD THRUST REVERSER SLEEVE. THE RPTR SAID ALL PAPERWORK WAS COMPLETE AND THE LOGBOOK SIGNED. THE RPTR STATED ON THE FIRST FLT THE COMPOSITE OUTER LINER OF THE L ENG OUTBOARD THRUST REVERSER DEPARTED THE ACFT. THE RPTR SAID THE SLEEVE WAS REPAIRED AND RETURNED SERVICEABLE BY A CONTRACT VENDOR. CALLBACK CONVERSATION WITH RPTR ACN 627670 REVEALED THE FOLLOWING INFO: THE RPTR STATED HE CANNOT REMEMBER THE INCIDENT.
Data retrieved from NASA's ASRS site as of July 2007 and automatically converted to unabbreviated mixed upper/lowercase text. This report is for informational purposes with no guarantee of accuracy. See NASA's ASRS site for official report.